腰椎手术失败综合征的再手术治疗

[目的]探讨腰椎手术失败综合征（FBSS）再手术治疗的方式和注意事项。[方法]对20例再手术治疗的腰椎手术失败综合征（FBSS）患者进行回顾性研究，综合分析FBSS患者的病史、体征、影像学表现以及术中探查结果等资料。术中行硬膜囊和神经根减压以及自体骨植骨融合，其中12例腰椎失稳的患者辅以椎弓根钉系统固定，术后进行一定的康复锻炼。[结果]术中损伤神经根1例，术后暂时性的脑脊液漏3例。治疗效果参照Ragab的评估标准进行综合评估。本组20例患者，治疗效果优12例，良5例，可2例，差1例；优良率为85％。[结论]FBSS是一多病因多表现的综合征，术前应当综合分析患者的临床表现，寻求病因，制订适宜的手术方案。     

腰椎手术失败的原因及再手术探讨

目的 分析导致腰椎手术失败的原因,探讨再手术的方法及疗效.方法 回顾分析2006-01-2010-01收治38例腰椎手术失败患者资料,所有病例均行再次手术治疗,其中经椎板间开窗或原椎板间扩大开窗切除椎间盘16例,半椎板切除减压椎间盘切除10例,全椎板切除减压椎间盘切除7例,经后路椎管减压椎弓根螺钉固定、植骨融合5例.结...     

腰椎手术失败综合征的原因评价与预防策略

目的：对腰椎手术失败综合征（FBSS）的发生原因进行分析和评价,为预防提供策略。方法：54例FBSS住院接受再手术患者,进行术前体检、影像学检查和手术探查。结果：FBSS的主要原因有：（1）椎间盘突出复发和邻近椎间盘突出。（2）椎管内瘢痕形成神经受压、中央性椎管狭窄。（3）神经根减压不充分、侧隐窝狭窄。（4）腰椎不稳。（5）神经损伤。（6）创伤性小关节炎。（7）手术节段错误。结论：FBSS发生原因较多,大部分为医源性。术中细致操作、彻底减压,术后良好康复是主要的预防策略。     

综述硬膜外瘢痕与腰椎手术失败综合征

腰椎手术失败综合征（failedbacksurgerysyndrome,FBSS）广义上泛指在行椎板切除术或椎间盘摘除术后,患者仍有腰部、臀部或下肢的顽固性疼痛或其他不适症状;狭义上仅指多次手术术后症状没有任何改善[1]。FBSS可能与手术失误有关,但也可发生于一次正确而彻底的手术之后。FBSS发病率约在10％～40％[2]。总体上,腰椎首次手术后需要再手术的约在5％～18％[3],首次手术为经皮穿刺椎间盘切除术的再手术率约在14％～33％,显微椎间盘切除术的再手术率约为7％～15％。再次手术的成功率由于不同的病理原因与不同评价标准,存在很大差异,为1…     

腰椎手术失败综合征的影像学评价和手术处理

目的对经一次髓核摘除手术的FBSS患者进行临床及影像学评价，分析FBSS的影像学特点及其临床预防与治疗。方法回顾性分析2000～2003年连续收治的32例FBSS患者的临床资料，根据临床及影像学评价，第二次诊断分别为：椎间盘再突出9例（28．1％）；邻近节段椎间盘突出3例（9．4％）；腰椎管及神经根管狭窄6例（18．8％）；腰椎不稳5例（15．6％）；椎管内肿瘤1例（3．1％）；神经根损伤1例（3．1％）；硬膜外瘢痕7例（21．9％）。对其中24例进行再次手术治疗。术后22例获得随访，随访时间1年以上（1～4年，平均2．3年）。结果第二次术后随访2例硬膜外疤痕形成，4例仍残留下肢麻木症状。5例不同程度伴有腰部的酸胀不适，未见内固定失败病例。结论硬膜外疤痕和椎间盘再突出是FBSS最常见的原因。术前全面评价和术中仔细操作是预防FBSS的有效方式。MRI扫描对鉴别硬膜外疤痕和椎间盘再突出价值最大。     

58例腰椎手术失败综合征的原因分析

目的：对58例腰椎手术失败综合征（FBSS）的原因进行分析，方法：对1995－2001年在我院进行腰椎手术的患者进行回顾，对其中58例FBSS的原因系统水平，结果：总结出9种FBSS的原因，结论：在进行腰椎手术中，如能尽量避免以上9种引起FBSS的原因，将极大提高手术者的诊疗水平。     

椎间孔镜治疗有典型根性症状的腰椎手术失败综合征

目的：评价椎间孔镜治疗有典型根性症状的腰椎手术失败综合征（failedbacksurgerysyndrome,FBSS）的临床效果。方法选择2012年11月～2013年6月12例有典型根性症状的FBSS,其中腰椎间盘突出单纯开窗髓核摘除术后复发5例,腰椎管狭窄髓核摘除并神经根管减压术后复发3例,腰椎间盘突出椎间孔镜髓核摘除术后复发4例。均采用椎间孔镜治疗。结果12例术后患肢直腿抬高试验阴性,神经根刺激所致的患肢疼痛症状均明显缓解,患肢疼痛评分依据视觉模拟评分法（visualanaloguescore,VAS）,术前8．3±1．9,术后1个月2．6±1．1（t＝16．301,P＝0．000）。结论椎间孔镜是治疗有典型根性症状的FBSS安全和有效的微创手术,合理选择手术适应证和成熟的椎间孔镜手术经验是保证手术成功的关键。     

腰椎间盘突出症开窗术后腰椎手术失败综合征及再手术

开窗术以其对脊柱稳定性干扰较小的突出优点,为治疗腰椎间盘突出症的经典术式。一组长期随访(8年以上)资料显示开窗组(37例)的平均恢复工作时间和恢复原工作率分别为4．3个月和84．6％。但因误诊误治和术后处理不当可致腰椎手术失败综合征(Failed Back Surgery Syndrome)的发生,我院自1995年1月-2003年2月,对单侧单间隙开窗摘除腰椎问盘术后FBSS 38例行再手术,疗效满意。     

腰椎手术失败综合征病因分析

腰椎术后失败综合征（FBSS）发生率约为10％～40％,严重困扰临床医师。其常见原因有以下几种：椎间盘切除术后再突出,椎管内硬膜外瘢痕增生致硬脊膜和神经根牵拉、挤压,椎间盘切除术后椎管狭窄,椎间盘切除术后腰椎不稳,诊断错误和遗漏,手术节段的定位错误,骨质疏松,自身免疫反应,化学因素等。     

腋臭失败手术采用负压吸引方法再次治疗的疗效分析

目的:评价腋臭术后复发者再次进行微创负压抽吸术治疗的有效性和安全性。方法:对曾经实施微创手术疗效不佳的患者32例(女性21例,男性11例),采用负压抽吸术再次治疗,记录术后并发症,患者满意度和医生对手术评估等,与首次实施负压抽吸术的腋臭患者382例(女性253例,男性129例)进行对比分析。结果:两组病例术后疗效和并发症无统计学差异。术后满意率再次手术组和首次手术组分别为91%vs93%(P0.05);没有发生严重并发症;再次手术组有5例(16%)因真皮和皮下脂肪瘢痕粘连导致操作困难。结论:微创负压抽吸术治疗腋臭及术后复发者同样有效,副作用少,值得临床推广应用。     

Revision surgery for failed back surgery syndrome.

Results of surgical treatment in 50 failed back surgery patients were retrospectively reviewed to determine what factors influenced surgical outcome. Before surgery, all patients had disabling pain and limited function. Overall significant improvement in pain and function was obtained in 66% of the patients. Thirteen of 16 patients (81%) who had successful fusion of pseudarthrosis had a satisfactory outcome, whereas only 3 of 13 patients (23%) who had failed pseudarthrosis repair had a satisfactory outcome. Successful pseudarthrosis repair is the key to a high clinical success rate in revision surgery for failed back surgery syndrome. Pseudarthrosis repair by conventional posterolateral fusion with postoperative lumbosacral corset immobilization showed a high failure rate. The success rate of reoperation on failed back surgery syndrome patients is low.     

CT evaluation of the failed back surgery syndrome

Inadequate low back care has now been clearly identified as perhaps the greatest single waste of health care resources in the United States. Low back care failure represents a particularly frustrating and challenging entity. Statistics suggest that 25,000 to 50,000 FBSS cases occur each year. This is a public health problem that should be of the highest level of concern. Modern understanding and technical prowess allow us to study past therapeutic failures and thus gain the knowledge necessary to do better in the future. We sincerely hope that our colleagues will give careful consideration to the material presented here.     

Results of instrumented posterolateral fusion in failed back surgery

The success rate following revision surgery for failed back surgery is inherently low. However, a general consensus for a satisfactory surgical intervention after failed disc surgery has not yet been reached. We present a cohort study of 25 adult cases treated by instrumented posterolateral fusion with or without nerve root exploration/decompression for recurrence or persistence of symptoms after previous disc surgery. The average age at surgery was 47 years (range 39–56 years). Complications were seen in four patients in the form of intraoperative dural tears. A satisfactory clinical outcome was seen in 80% of the patients, and the overall fusion rate was 93%.

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Résumé La reprise de chirurgie discale par abord postérieur donne des résultats peu satisfaisants. Nous avons étudié une cohorte de 25 adultes traités par instrumentation postéro latérale avec greffe, avec ou sans décompression radiculaire pour une symptomatologie persistante après chirurgie discale. L’age moyen de la chirurgie a été de 47 ans (de 39 à 56). Des complications ont été observées chez 4 patients (lésion intra durale per-opératoire). Le résultat clinique a été satisfaisant chez 80% des patients avec un taux de réussite de la greffe de 93%.

     

Use of pulsed radiofrequency in failed back surgery syndrome

Failed back surgery syndrome (FBSS) is a well-recognized complication of spinal surgery. Pulse radiofrequency of dorsal root ganglion has been recently described for such patients. In this report, pulsed radiofrequency was applied in 3 patients with failed back surgery syndrome, presenting with severe pain. Reasonable to good pain relief was achieved in 2 patients in 6 months follow-up, however, one patient got short-term pain relief. Based on this limited experience in FBSS where conventional and non-conventional treatments are not effective, pulsed radiofrequency may be considered a logical choice.     

Clinical outcome of surgical treatment of failed back surgery syndrome

BACKGROUND: Failed back surgery syndrome (FBSS) is a condition in which there is failure to improve satisfactorily after back surgery. It is characterized by intractable pain and various degrees of functional disability after lumbar spine surgery. It is estimated that this complication occurs in 5% to 10% of patients after spinal surgeries. The major causes of FBSS are fibrosis and adhesions, spinal instability, recurrent herniated disk, and inadequate decompression. The purpose of this study is to report on the postsurgical outcome after a redo spinal surgery. METHODS: We prospectively studied 50 patients with FBSS. The underlying pathology was identified and all the patients were treated surgically. Redo surgery was targeted at correcting the underlying pathology: removal of recurrent or residual disk, release of adhesions with neural decompression, and fusion with or without instrumentation. The postsurgical outcome was studied using the Oswestry Disability Questionnaire (ODQ). RESULTS: The average preoperative ODQ mean score was 80.8; the average postoperative ODQ mean score was 36.6 at 1 month and 24.2 at 1 year. Best scores were obtained at 3 months of follow-up in most cases. Successful outcome (>50% pain relief) could be achieved in 92% of the patients at 1 year. CONCLUSION: The current study shows that successful management of patients with FBSS could be achieved with proper patient selection, correct preoperative diagnosis, and adequate surgical procedure targeting the underlying pathology.     

Pathogenesis,etiology and treatment of failed back surgery syndrome

Failed back surgery syndrome (FBSS) is associated with persistent lower back pain after and despite one or more surgical interventions. A number of factors underlie and maintain FBSS and successful management of pain chiefly depends on identifying them. Pharmacological, surgical, and non-surgical therapeutic measures are taken to treat the pain. Spinal cord stimulation and nerve stimulation have been widely practiced in this regard and enhanced pain reduction and patient satisfaction. In hernia and recurrent disc degeneration and sagittal imbalance, discectomy and/or fusion are indicated. The present review focuses on FBSS and its underlying components and on available treatment options.